Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Biostatistics, Christian Medical College, Vellore, India.
Updates Surg. 2022 Feb;74(1):97-105. doi: 10.1007/s13304-021-01202-4. Epub 2021 Nov 2.
We conducted this study to evaluate the ability of indocyanine green (ICG) and near infra-red fluorescence (NIRF) camera to aid in the identification and assessment of viability of parathyroid glands during thyroid surgery. A prospective observational study was conducted between May and October 2020 among 50 consecutive patients who underwent total thyroidectomy at a single institution. Parathyroid glands were identified under white light during thyroidectomy following which reconstituted ICG was injected through a peripheral vein and the location of parathyroid glands was confirmed. The perfusion to the parathyroid gland was assessed by documenting the fluorescence intensity score (FIS) and the parathyroid angiogram score (PAS). There was no difference in the number of parathyroid glands seen on visual inspection 147 (73.5%) when compared to under NIRF camera, 146 (73%). Though the rate of postoperative hypoparathyroidism was lower in the cohort with FIS 3 (14.2%) compared to score 2 and 1 (28.5% and 100%, respectively), this was not significant (p = 0.35). A significant correlation was noted between a delayed flow on PAS and the development of post-thyroidectomy hypoparathyroidism (p = 0.01). PAS had a sensitivity of 100%, specificity of 88.6%, NPV of 100% and PPV of 55.6% to predict the development of post-thyroidectomy hypoparathyroidism. In this study, there was no additional benefit of ICG and NIRF camera in the identification of parathyroid glands. However, ICG angiogram seems to be a good adjunct for the intraoperative assessment of the viability of the parathyroid glands and accurately predicts the development of postoperative hypoparathyroidism.
我们进行这项研究是为了评估吲哚菁绿（ICG）和近红外荧光（NIRF）相机在甲状腺手术中辅助识别和评估甲状旁腺活力的能力。这是一项在 2020 年 5 月至 10 月期间在一家机构进行的前瞻性观察研究，共有 50 例连续接受全甲状腺切除术的患者入组。在甲状腺切除术中，甲状旁腺在白光下被识别，然后通过外周静脉注射重组 ICG，并确认甲状旁腺的位置。通过记录荧光强度评分（FIS）和甲状旁腺血管造影评分（PAS）来评估甲状旁腺的灌注情况。与 NIRF 相机相比，在视觉检查时看到的甲状旁腺数量没有差异，分别为 147 个（73.5%）和 146 个（73%）。尽管 FIS 为 3 的患者（14.2%）术后甲状旁腺功能减退的发生率低于 FIS 为 2 和 1 的患者（分别为 28.5%和 100%），但差异无统计学意义（p=0.35）。PAS 上的延迟血流与甲状腺切除术后甲状旁腺功能减退的发生之间存在显著相关性（p=0.01）。PAS 预测术后甲状旁腺功能减退的敏感性为 100%，特异性为 88.6%，阴性预测值为 100%，阳性预测值为 55.6%。在这项研究中，ICG 和 NIRF 相机在甲状旁腺的识别中没有额外的益处。然而，ICG 血管造影似乎是评估甲状旁腺活力的良好辅助手段，可准确预测术后甲状旁腺功能减退的发生。
